Non-Clinical Support » Legal and Medico Legal issues

Do's & Dont's for Doctors

Having trained ONLY to heal, Doctors are not very mediquettes savvy and inspite of having done justice to the problem at hand may leave the patient with a feeling that enough time/ attention was not given. Doctors always wonder what they should do and what they should not do. Following are some of the guidelines.

Do's for Doctors

• Mention age & sex of the patient. In a pediatric prescription, weight of the patient must also be mentioned.
• Always put your hand on the part that the patient / attendant says is painful. Apply your stethoscope on him, even if for cosmetic reasons.
• Listen attentively. Look carefully. Ask questions intelligently.
• If, after completing the examination, the patient / attendant feels that something has been left out or wants something to be re-examined, oblige him.
• Always face the patient. Maintain eye contact that is comfortable to the patient. Some patients tolerate very little eye contact. Learn to observe out of the corner of your eyes.
• In case you have been distracted / inattentive during the history taking, ask the patient / attendant to start all over again. He will never mind it. As far as possible, consultations should not be interrupted for non-urgent calls.
• Ask the patient to come back for review the next day, in case you have examined him hurriedly or if you are not sure about the diagnosis / treatment.
• Mention "diagnosis under review" or "quot;under evaluation" until the diagnosis is finally settled.
• If the patient / attendants are erring on any count make a note of it or seek written refusal.
• Record history of drug-allergy.
• Write names of drugs clearly. Use correct dosages and mention clearly method & interval of administration and mention side effects.
• In a particular drug / equipment is not available, make a note.
• Prescribe with caution during pregnancy / lactation.
• Adjust doses in case of a child / elderly patient and in renal or hepatic disorders.
• Mention where the patient should contact in case of your non-availability / emergency.
• If you are not sure what disease a patient has after a thorough work-up, get a consultation with a referring note and show your concern.
• Update your knowledge and skill from time to time. Many doctors tend to deteriorate in their knowledge, skills & attitude, over a period of time. Not only do they make any attempt to update themselves, but also they slip downwards.
• Preferably employ qualified assistants.
• Always obtain a legally valid consent before undertaking a surgical / diagnostic procedure.
• It is mandatory to screen every patient for Hepatitis B/ HIV infection before every surgery, blood transfusion so that false claims are not made at a later date.
• In case of MTP/ Sterilization, always follow the guidelines issued by the Government of India.
• Routinely advise X-rays in injury to bones & joints and related diseases of bones / joints.
• Always rule out pregnancy before subjecting the uterus to X-ray.
• Always read reports carefully & interpret the results of tests / X-rays properly and make a note of it. In case of any doubt, recheck with the lab / diagnostic centre.
• In all instances of swab cases & "instrument cases", the surgeon incharge is generally held directly or vicariously liable for negligence. The surgeon incharge must therefore personally ensure that such mishaps do not occur.
• The period for the responsibility of the surgeon extends to and includes the post-operative care. He must, therefore, ensure proper post-operative care to the patient.
• In case of death of a patient occurring while undergoing surgery / diagnostic procedure, the higher hospital authorities / police authorities must be informed without loss of time. In such cases, autopsy/post-mortem is mandatory.
• In case the hospital / clinic claim to provide 24-hour emergency service, availability of necessary equipment in working order and competent staff within reasonable time is mandatory.
• Always seek proper legal and medical advice before sending reply to the notice sent by the patient or his representative or to the complaint referred to you from a consumer court.

Dont's for Doctors

• Don't prescribe without examining the patient.
• Never examine a female patient without the presence of female nurse / attendant, especially during genital & breast examination.
• Don't insist on the patient to tell the history of illness or be examined in presence of others. He has a right to privacy and confidentiality.
• Don't prescribe a drug or indulge in a procedure if you cannot justify its indication.
• Don't prescribe or administer a drug which is banned, e.g. Analgin, Oxyphenbutazone etc.
• Don't over-prescribe - too much of the drug, too large a dose, for too long.
• Don't under-prescribe - not prescribing the needed drug, dose is too small, length of treatment is too short. Calculate proper dose, esp in children.
• Don't prescribe multiple drugs. Such prescription may be due to inability to form a correct diagnosis or other causes. Possibilities of drug interactions increase with polypharmacy.
• Don't write instructions on a separate slip. Don't allow substitutions.
• Don't do anything beyond your level of competence. Competence of doctors, nursing staff is defined by their qualification, training, experience and competence of a hospital/nursing home is defined, in addition to the competence of its doctors and nursing staff by the availability of various equipments in working order and back-up support, e.g. handling of cases of accident/emergency, severe reaction to drugs, anesthesia, etc. and availability of resuscitative equipment., etc.
• Don't refuse if the patient/attendant wants to leave against medical advice. It is their right. Document this properly.
• Never avoid a call for help from a nurse on duty at night. In all probability, a genuine emergency may be there.
• Don't refuse the patient's right to know about diagnosis & treatment of his illness.
• Don't withhold information, however harsh & difficult, in seriously/ terminally ill patients. It must be conveyed with compassion & gradually, if time permits.
• Don't leave at the time of death. There is a tendency, especially on the part of the senior doctors, to go away at this time when their presence and experience are most needed.
• Don't hesitate to extend your condolences and sympathies to the bereaved persons.
• Don't forget to provide genetic counselling to couples and parents with known family history/children having genetic abnormalities, e.g. Thalassemia, Hemophilia, etc.
• Don't issue death certificates unless you have yourself verify death.
• Don't refuse the patient's right to examine and receive an explanation about your bill regardless of the source of payment; whether it is reimbursed by the government or by his employer/insurance company.
• Don't refuse the patient's right to know about the hospital rules & regulations.
• Don't dump hospital garbage including used disposables in the open. It should be properly incinerated / destroyed to prevent spread of disease or reuse by unscrupulous persons.
• Don't refuse first-aid/medical care to accidents & emergency cases even if it is a medico-legal case. It is a primary duty of every doctor/hospital to provide treatment upto his/its true level of competence in such cases before referring them to a higher centre, if required.
• Never talk loose of your colleagues, despite intense professional rivalry. It is bound to come back to you and patients also do not appreciate it.